Association between cardiometabolic disease multimorbidity and all-cause mortality in 2 million women and men registered in UK general practices

Abstract

Background Myocardial infarction (MI), stroke and diabetes share underlying risk factors and commonalities in clinical management. We examined if their combined impact on mortality is proportional, amplified or less than the expected risk separately of each disease and whether the excess risk is explained by their associated comorbidities. Methods Using large-scale electronic health records, we identified 2,007,731 eligible patients (51% women) and registered with general practices in the UK and extracted clinical information including diagnosis of myocardial infarction (MI), stroke, diabetes and 53 other long-term conditions before 2005 (study baseline). We used Cox regression to determine the risk of all-cause mortality with age as the underlying time variable and tested for excess risk due to interaction between cardiometabolic conditions. Results At baseline, the mean age was 51 years, and 7% (N = 145,910) have had a cardiometabolic condition. After a 7-year mean follow-up, 146,994 died. The sex-adjusted hazard ratios (HR) (95% confidence interval [CI]) of all-cause mortality by baseline disease status, compared to those without cardiometabolic disease, were MI = 1.51 (1.49–1.52), diabetes = 1.52 (1.51–1.53), stroke = 1.84 (1.82–1.86), MI and diabetes = 2.14 (2.11–2.17), MI and stroke = 2.35 (2.30–2.39), diabetes and stroke = 2.53 (2.50–2.57) and all three = 3.22 (3.15–3.30). Adjusting for other concurrent comorbidities attenuated these estimates, including the risk associated with having all three conditions (HR = 1.81 [95% CI 1.74–1.89]). Excess risks due to interaction between cardiometabolic conditions, particularly when all three conditions were present, were not significantly greater than expected from the individual disease effects. Conclusion Myocardial infarction, stroke and diabetes were associated with excess mortality, without evidence of any amplification of risk in people with all three diseases. The presence of other comorbidities substantially contributed to the excess mortality risks associated with cardiometabolic disease multimorbidity.

Association between healthy lifestyle and the occurrence of cardiometabolic multimorbidity in hypertensive patients: a prospective cohort study of UK Biobank

“…Hypertension is the most significant cause of early death globally [ 53 ] and the first leading risk factor for global disease burden [ 54 , 55 ]. When patients with hypertension occur CMM, it further increases mortality and shortens life expectancy [ 1 – 3 , 5 ]. Since our results showed that a combination of healthy lifestyle may reduce the risk for CMM in patients with hypertension, any practices and policies that support the adoption of healthy lifestyle factors are encouraged as they will improve the overall health of the population.…”

Health screening of middle-aged women: what factors impact longevity?

“…The combination of these diseases doubled the risk of mortality. 21 In addition to the increase in mortality from cardiovascular diseases in diabetic patients, it has been observed that they have a higher risk of cancer. Indeed, a systematic review with analysis of 203 cohorts (56,852,381 participants; 3,735,564 incident cancer cases; and 185,404 cancer deaths) that covered the period 1951-2013 found that the relative risk of all-site cancer mortality in diabetics was 1.23 (95% CI, 1.15-1.31).…”

“…This study showed a higher risk of mortality in people who at the beginning of follow-up had a history of diabetes (HR, 1.52; 95% CI, 1.51-1.53) or myocardial infarction (HR, 1.51; 95% CI, 1.49-1.52). The combination of these diseases doubled the risk of mortality 21 . In addition to the increase in mortality from cardiovascular diseases in diabetic patients, it has been observed that they have a higher risk of cancer.…”

Long-term air pollution, cardiometabolic multimorbidity, and genetic susceptibility: a multi-state modeling study of 415,855 participants

“…Additionally, except for the limited death numbers, null associations between air pollution and the CMM-death process may be explained by better medical care for CMM patients. A recent study of CMM and mortality in UK general practices have demonstrated that compared with people with individual CMDs, those with multimorbidity could have a higher likelihood of receiving evidence-based treatment to lower the exceeded risk of coexisting cardiovascular and metabolic diseases (33).…”